Surgical clamp

ABSTRACT

A surgical clamp for application directly to the liver parenchyma which includes a rigid elongated base member for supporting two flexible foam rubber covered blades and a means for the independent adjustment of each blade. A handle is attached to one end of the clamp base for the convenience of the operator in positioning the clamp and manipulating the liver for better exposure. When properly positioned one blade is bent through tension to conform to the shape of the superior surface of the liver, and the other blade is arched through compression against the inferior surface of the liver to achieve tight compression through blade cooperation.

Unite States atent Duty et a1. [4 June 6, 1972 [541 SURGICAL CL 3,176,368 4/1965 Sampson ..24 280 [72] Inventors: Donald B. Doty, Silver Spring; Heinz W. FOREIGN PATENTS OR ppuc o s Kugler, College Park, both of Md. 172,169 12/1921 Great Britain ..24/280 [73] Assignee: The United States of America as represented by the Secretary of the Army Primary Examiner-Channing L. Pace Attorney-Alva H. Bandy and William G. Gapcynski [5 7] ABSTRACT A surgical clamp for application directly to the liver parenchyma which includes a rigid elongated base member for supporting two flexible foam rubber covered blades and a means for the independent adjustment of each blade. A handle is attached to one end of the clamp base for the convenience of the operator in positioning the clamp and manipulating the liver for better exposure. When properly positioned one blade is bent through tension to conform to the shape of the superior surface of the liver, and the other blade is arched through compression against the inferior surface of the liver to achieve tight compression through blade cooperation.

4 Claims, 3 Drawing Figures PATENTEDwf- .v

' INVENTORS DONALD B. DOTY a HEINZ w. KUGLER BY 5% x;

SURGICAL CLAMP The invention described herein may be manufactured and used by or for the Government for governmental purposes without the payment to us of any royalty thereon.

BACKGROUND OF THE INVENTION 1. Field of the Invention The invention is in the field of art relating to surgical instruments and in particular to surgical clamps.

2. Description of the Prior Art No prior art has been found relating to surgical clamps for liver operations. A tourniquet which includes a base adapted to carry a flexible band or strip adapted to be drawn about a limb and a compression member capable of quick adjustment against an artery for stopping the flow of blood through the artery is taught in US. Pat. No. 1,281,643, dated Oct. 15, 1918, to H. W. Plummer.

A vein retainer which utilizes a plate to support a pair of adjustable vein retaining fingers and a flexible strap to retain the plate on a part of the body is taught by U.S. Pat. No. 1,824,516, dated Sept. 22, 1931, to R. E. Tyvand.

SUMMARY OF THE INVENTION In liver surgery difficulty has been encountered in moving and positioning this large organ, and in controlling hemorrhaging from the cut surface. In addition, air embolism is a constant hazard during hepatic venous drainage. Unfortunately none of the accepted methods for hemostasis is uniformly successful and most require temporary interruption of blood supply to uninvolved portions of the liver and the possible consequences of ischemia.

Thus, it is an object of this invention to provide a hemostatic instrument which may be applied directly to the liver parenchyma to control the divided hepatic surface to avoid the possible consequences of ischemia.

Another object of the invention is to provide a hemostatic instrument which after being applied directly to the liver parenchyma may be manipulated to move or position the liver for surgery. 1

Still another object is to provide a surgical clamp for control of hemorrhage from the cut surface of the liver, and to minimize the hazard of air embolism during division of hepatic venous drainage.

Briefly stated the invention comprises a rigid elongated base providing support for two flexible blades. One blade is adapted for tension adjustment to conform it to the superior surface of the liver. The second blade is adapted to be compressed for arching or elevating it away from the base into engagement with the inferior surface of the liver. The compression blade in the arched position coacts with the first blade to place maximal compression centrally of the liver where the large blood vessels and ducts are located. Foam rubber sheaths encase the blades to allow atraumatic application and to prevent slipping on the liver surfaces. A handle is provided adjacent one end of the base for manipulating the instrument for moving and positioning the liver.

BRIEF DESCRIPTION OF THE DRAWINGS DESCRIPTION OF THE PREFERRED EMBODIMENT Referring to the drawings, the surgical instrument construction of the present invention comprises a rigid elongated base 10 terminating at one end in a depending handle 12, and at the opposite end in a longitudinal threaded well adapted to receive a blade retaining screw 14. The handle and elongated base are preferably made of stainless steel. Thus, the handle may be formed from the base material during construction of the instrument by bending a portion of the base to form a portion 16 which extends from the base to a bend across a transverse zone from which begins a handle portion 18 which slants outwardly from the first mentioned portion 16 as shown in FIG. 3.

A curved index finger grip 20 is provided on the handle side of the base 10, and a spring loaded thumb latch 22 is supported in a spaced relationship to the surface of the base opposite the handle side between the finger grip and handle by a pair of brackets 24 rigidly secured to the elongated vertical sides of the base 10.

The space defined by the thumb latch, brackets, and base surface beneath the latch constitutes a passage 26 for a pair of flexible blades 28 and 30. The blades are preferably made of a polycarbonate resin or of spring stainless steel. Blade 28, hereinafter referred to as the superior blade because in operation it engages the superior surface of the liver, has an aperture in one end for receiving the blade retaining screw 14 to fasten the blade to the base 10. A body portion of the superior blade 28 begins with an elongated transverse slot 34 adjacent the blades apertured end, and terminates in a portion having a plurality of longitudinally disposed apertures which extend through the passage 26 formed beneath the thumb latch. Blade 30, hereinafter referred to as the inferior blade because in operation it engages the inferior surface of the liver, has a notched end 36 fitted into the slot 34 of the superior blade to secure the inferior blade beneath the superior blade just above the base 10. The inferior blade 30 passes through the passage 26 formed beneath the thumb latch and terminates in a block 38 slidably mounted in the base 10.

The block 38 has sides 40 having inwardly extending flanges to form a retaining guide for the superior blade. The inferior blade carrying portion of the block 38 rests upon the base 10 and has a depending guide portion 42 adapted to be received in an elongated slot provided in the base 10 between the thumb latch and handle end of the base. A post 44 depends from the lower guide portion of the block and terminates in a journal box. A lead screw 48 has one end forming a journal 50 rotatably mounted in the journal box. A threaded body portion 52 of the lead screw passes through a correspondingly threaded aperture provided in the portion 16 of the handle which is normal to the base. The end of the lead screw opposite the journal end carries an operating member 54 shown in FIGS. 1 and 3 as a longitudinally disposed cylindrical head having its periphery serrated for obvious reasons.

The spring loaded thumb operating latch 22 has a housing for a pin 56. A spring 58 is carried in the housing above the pin for urging the pin into the passage 26 for engaging any one of the plurality of apertures provided along the end portion of the superior blade 28. A lever 60 is pivotally mounted within the housing at a point between its ends. One end of the lever as shown in FIG. 2 is integral with the pin 56 which is perpendicular to the lever. The other end of the lever constitutes a head 62 formed to accommodate an operator's thumb.

It will be readily seen from FIGS. 1 and 2 that the finger grip, thumb latch, and handle are positioned as to each other to provide a pistol like grip for steady manipulation of the instrument and operation of the thumb latch by one hand of an operator thereby leaving the other hand free to manipulate the lead screw head and the superior blade.

Although the blade arrangement described above is that shown in the figures it will be understood that the notched end of the inferior blade may be replaced by an apertured end corresponding to that of the superior blade and both blades secured to the base by the threaded screw. This arrangement is not preferred, however, as the sharp bend resulting in the end of the inferior blade interferes in the dressing of the blade in the foam rubber sheath.

In operation the surgical instrument is prepared for use by releasing the blades from the base and each other and covering the blades with the foam rubber sheaths and securing the blades. The thumb latch is depressed to disengage the pin from the superior blade 28 which may then be slid forward or backward to respectively increase or decrease the amount of blade curvature to obtain a desired curvature away from the base and the thumb latch released which enables the latch spring to urge the pin into an aperture of the superior blade to retain the desired blade position. The inferior blade 30 is brought substantially parallel to the base by rotating the lead screw to retract the inferior blade block. The instrument is then ready to receive the liver between the superior and inferior blades. After liver insertion the thumb latch is again depressed and the superior blade roughly adjusted by pulling it through the passage and guide to conform the blade to the superior surface of the liver. The thumb latch is released for pin insertion into an aperture of the superior blade to retain the blade adjustment. The inferior blade is then elevated into an arch by rotating the lead screw to drive the inferior blade holding block forward to compress the blade. The inferior blade in its arched position coacts with the superior blade to provide maximum pressure in the middle of the blades to close off the large blood vessels and ducts located centrally of the liver. After use the clamp is disengaged by depressing the thumb latch to the superior blade, or by removing the threaded screw holding the superior blade to the base and pinching the notched end of the inferior blade to remove it from the slot in the superior blade, or by manipulating the lead screw to withdraw the inferior blade block.

We claim:

1. An apparatus for clamping and positioning an organ such as the liver which comprises:

a. an elongated, planar base;

b. a pair of flat, mutually spaced, flexible, cooperating blades, extending lengthwise of said planar base, said blades aligned with said base and each having one of its ends secured to one end of said base, one of said blades remote from said planar base being an upper blade and a second one of said blades intermediate said planar base and said upper blade being a lower blade, said upper blade having apertures therethrough for a portion of the length thereof remote from said secured end;

c. upper blade adjusting means fixedly secured to said planar base adjacent the end opposite the end to which the blades are secured and including latch means for engaging said apertures in said upper blade to retain said upper blade in an adjusted, arched position relative to said planar base upon selective engagement of said latch means with one of said apertures;

. lower blade compression means carried by said planar base and movable relative thereto, said lower blade compression means positioned between said upper blade adjusting means and said opposite end and fixedly securing a second end of said lower blade and slidably retaining said upper blade, movement of said lower blade compression means relative to said planar base in a direction toward said latch means producing a clamped, arched position of said lower blade relative to said planar base and said upper blade; and

e. said lower blade compression means contacting said upper blade adjusting means when said upper and lower blades are in operative position adapted to clamp the liver or like organ to maintain said upper and lower blades in an arched, operative, clamped position.

2. An apparatus as recited in claim 1 wherein said base comprises:

a. a rigid elongated member;

b. a handle depending from one end of said elongated member;

c. a finger grip depending from said elongated member in space relation and forward of said handle for a pistol like d. l de retaining means at the end opposite said handle;

and

e. an elongated guide slot in said rigid elongated member adjacent said handle.

3. An apparatus as recited in claim 1 wherein said upper blade adjusting means carried by said base for retaining said upper blade in an adjusted position on said base comprises a spring loaded thumb operating latch having depending spaced sides secured to said base to form a blade passage with said base for said pair of blades and to engage one of said apertures in said upper blade to retain adjustment of said upper blade.

4. An apparatus as recited in claim 1 wherein said blade compression means comprises:

a. a slidable block resting on said base and having said second end of said lower blade fixed thereto, a portion of said block depending through said guide slot, and a journal box included in said portion of said block and extending below said base; and

b. a lead screw having one end journaled in said journal box,

a threaded body portion passing through a correspondingly threaded aperture in said handle, and a head for operating said lead screw, said lead screw being carried by said journal box and said handle in a substantially parallel position to said base. 

1. An apparatus for clamping and positioning an organ such as the liver which comprises: a. an elongated, planar base; b. a pair of flat, mutually spaced, flexible, cooperating blades, extending lengthwise of said planar base, said blades aligned with said base and each having one of its ends secured to one end of said base, one of said blades remote from said planar base being an upper blade and a second one of said blades intermediate said planar base and said upper blade being a lower blade, said upper blade having apertures therethrough for a portion of the length thereof remote from said secured end; c. upper blade adjusting means fixedly secured to said planar base adjacent the end opposite the end to which the blades are secured and including latch means for engaging said apertures in said upper blade to retain said upper blade in an adjusted, arched position relative to said planar base upon selective engaGement of said latch means with one of said apertures; d. lower blade compression means carried by said planar base and movable relative thereto, said lower blade compression means positioned between said upper blade adjusting means and said opposite end and fixedly securing a second end of said lower blade and slidably retaining said upper blade, movement of said lower blade compression means relative to said planar base in a direction toward said latch means producing a clamped, arched position of said lower blade relative to said planar base and said upper blade; and e. said lower blade compression means contacting said upper blade adjusting means when said upper and lower blades are in operative position adapted to clamp the liver or like organ to maintain said upper and lower blades in an arched, operative, clamped position.
 2. An apparatus as recited in claim 1 wherein said base comprises: a. a rigid elongated member; b. a handle depending from one end of said elongated member; c. a finger grip depending from said elongated member in space relation and forward of said handle for a pistol like grip; d. blade retaining means at the end opposite said handle; and e. an elongated guide slot in said rigid elongated member adjacent said handle.
 3. An apparatus as recited in claim 1 wherein said upper blade adjusting means carried by said base for retaining said upper blade in an adjusted position on said base comprises a spring loaded thumb operating latch having depending spaced sides secured to said base to form a blade passage with said base for said pair of blades and to engage one of said apertures in said upper blade to retain adjustment of said upper blade.
 4. An apparatus as recited in claim 1 wherein said blade compression means comprises: a. a slidable block resting on said base and having said second end of said lower blade fixed thereto, a portion of said block depending through said guide slot, and a journal box included in said portion of said block and extending below said base; and b. a lead screw having one end journaled in said journal box, a threaded body portion passing through a correspondingly threaded aperture in said handle, and a head for operating said lead screw, said lead screw being carried by said journal box and said handle in a substantially parallel position to said base. 